{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEANNIE   P BOOTH","gend":1,"add":"2394 JULIA SIMPKINS ROAD","city":"HIWASSEE","state":"VA","zip":"24347-2204","dob":"1972-12-18","age":"","mstatus":"","insh":10054580,"cliId":"","pno":5403208690,"cno":5403208195,"email":"","ename":"","eno":"","pphy":"REBKOVICH, KELLY N","ppno":5406744560,"pcpadd":"141 Ben Bolt Ave, ","pcpcity":"Tazewell","pcpstate":"VA","pcpzip":246519700,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":5403205447,"add2":"                                                            ","add3":"","madd1":"2394 JULIA SIMPKINS ROAD","madd2":"                                                            ","madd3":"","mcity":"HIWASSEE","mstate":"VA","mzip":"24347-2204","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N89.8","N93.9","N95.1","Z90.711","R10.2","M54.5","R68.89","I89.0","Q82.0","R00.1","M79.7","N28.9","I95.9","R07.89","I49.5","R10.11","R10.12","R11.2","R19.7","R10.30","K21.9","I45.10","R94.31","R10.32","K59.00","R56.9","K63.5","K64.8","K44.9","K20.9","E78.5","N18.9","F32.9","K29.70","Z95.0","R06.02","R05","R53.83","G40.909","F31.9","Z20.828","R30.0","R09.89","M17.12","R07.81","E86.0","R10.9","Z86.711","Z51.81","F31.4","J90","F39","Z79.82","R94.39","R07.9","N83.202","H53.482","Z12.4","R35.0","G43.709","M19.90","Z12.31","R92.8","K31.9","K29.00","D12.3","K63.89","R07.2","M25.552","M25.562","M25.561","G47.33","E66.9","I42.8","G45.9","G60.9","M23.92","M23.301","M23.304","R52","T43.292A","I26.99","D86.9","F41.9","N18.2","Z88.1","Z88.2","Z91.5","T43.212A","F34.1","G89.4","L02.91","Z79.01","K62.5","R10.31","R11.0","K62.89","Z90.49","R00.2","R91.1","Z45.018","J98.11","I51.7","R60.9","R10.13","I12.9","N18.3","Z86.73","R51","N20.0","E83.51","R41.3","T14.8XXA","R60.0","T78.40XA","R21","R41.82","T14.91XA","R40.20","T43.011A","T43.222A","R10.10","T23.002A","X15.3XXA","Z79.899","Z68.42","R73.9","K58.0","R11.10","K58.9","G47.30","Z68.43","H10.9","R42","F31.81","Z95.810","Z98.84","M54.9","M47.816","M43.16","E66.01","Z87.42","R10.84","K20.8","M79.606","W19.XXXA","L76.22","M79.605","F32.2","T23.102A","X12.XXXA","I49.8","I45.89","M62.81","N39.0","R20.2","Z01.818","K59.09","D12.2","K64.4","K21.0","D86.0","R55","R53.1","E78.2","E55.9","G43.109","R51.9","B34.9","M54.2","R40.4","G44.52","R50.9","R63.0","R31.9","R07.1","N28.89","J34.89","R87.810","S90.32XA","M79.672","W22.09XA","M25.569","F31.30","I26.94","Z76.89","T23.232A","X50.1XXA","Z01.810","N83.209","G43.909","G89.29","Z87.09","K59.4","H92.09","W22.8XXA","S83.242A","S83.249A","X58.XXXA","S83.282A","E78.00","M96.831","N18.30","Z90.710","N25.81","H91.90","F41.8","M13.851","M46.96","Z88.6","E03.9","R53.82","R26.81","K57.30","R09.81","R04.0","I25.10","A41.9"],"date":["2019-01-08","2020-01-06","2019-01-08","2020-07-18","2019-01-17","2020-10-06","2020-07-31","2020-05-20","2019-10-16","2019-10-15","2020-01-20","2020-03-19","2019-05-31","2020-10-24","2019-04-17","2020-09-12","2020-06-28","2020-09-09","2020-09-12","2019-12-22","2020-10-30","2020-10-24","2020-10-24","2020-09-09","2020-09-09","2020-10-24","2020-01-20","2020-01-20","2020-09-12","2020-01-20","2020-10-30","2020-10-30","2020-09-12","2020-06-07","2020-10-24","2020-07-29","2020-06-30","2020-10-23","2020-10-30","2020-10-30","2020-10-30","2020-06-30","2020-06-30","2020-07-24","2020-07-29","2020-08-18","2020-10-19","2020-10-19","2020-10-26","2020-09-23","2020-07-16","2020-07-20","2019-09-30","2019-07-16","2020-10-24","2020-03-15","2019-10-01","2019-10-02","2020-07-14","2020-03-17","2020-09-18","2019-12-22","2019-12-22","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-10-23","2020-04-09","2020-06-15","2020-04-09","2020-04-30","2020-07-16","2020-05-20","2020-05-14","2020-05-20","2020-06-24","2020-06-24","2020-06-24","2020-07-17","2020-07-18","2020-08-19","2020-10-23","2020-07-23","2020-07-22","2020-07-18","2020-07-18","2020-07-18","2020-07-18","2020-07-22","2020-07-22","2020-08-19","2020-10-30","2020-10-10","2020-10-10","2020-10-23","2020-10-10","2020-10-24","2020-10-30","2019-02-25","2019-04-17","2019-04-18","2020-04-28","2019-07-08","2019-09-18","2020-10-24","2020-01-20","2020-10-24","2020-08-20","2020-09-12","2020-03-19","2020-03-19","2020-03-19","2020-06-09","2020-07-14","2020-07-14","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-22","2020-09-12","2020-09-24","2020-09-24","2020-05-11","2019-01-22","2019-05-31","2019-01-31","2020-06-30","2019-01-31","2019-05-31","2020-08-18","2019-06-14","2020-10-30","2020-05-20","2019-07-16","2020-01-20","2020-10-30","2019-11-14","2019-11-14","2020-08-18","2020-01-06","2020-01-20","2020-01-20","2020-04-09","2020-04-09","2020-05-26","2020-06-09","2020-07-20","2020-09-24","2020-09-24","2020-10-24","2020-10-24","2020-10-30","2020-04-23","2019-12-17","2019-07-12","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-06-30","2020-10-30","2020-09-18","2020-09-18","2020-09-18","2020-10-30","2020-10-30","2020-10-30","2019-12-18","2019-02-19","2019-09-18","2019-09-18","2019-09-18","2019-09-20","2019-12-22","2020-01-15","2020-01-23","2020-03-06","2020-03-06","2020-03-06","2020-05-11","2020-07-16","2020-07-22","2020-07-29","2020-09-25","2020-10-06","2019-04-17","2019-10-15","2019-12-17","2019-12-17","2019-12-17","2019-12-27","2019-12-27","2020-03-06","2020-05-26","2020-05-20","2020-05-20","2020-05-26","2020-05-20","2020-05-20","2020-10-24","2020-10-24","2019-01-17","2019-04-17","2019-04-17","2019-04-18","2019-04-18","2019-04-18","2020-01-03","2019-10-15","2020-01-10","2020-03-15","2020-04-23","2020-04-23","2020-04-30","2020-08-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","43547030703","ARIPIPRAZOLE ","TAB 30MG","30","Select","Select",""],["","00115166003","PROPRANOLOL ","TAB 20MG","60","Select","Select",""],["","40985027288","VITAMIN ","TAB 5000UNIT","30","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","12","Select","Select",""],["","69097012403","TOPIRAMATE ","TAB 100MG","60","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","60","Select","Select",""],["","50428054089","CVS ","CAP 5000UNIT","90","Select","Select",""],["","51672128901","NYSTATIN ","CRE 100000","30","Select","Select",""],["","00023916360","RESTASIS ","EMU 0.0005","180","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","45802057178","FEXOFENADINE ","TAB 180MG","90","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","200","Select","Select",""],["","00591252001","CHLORZOXAZON ","TAB 500MG","90","Select","Select",""],["","00456240560","SAPHRIS ","SUB 5MG","60","Select","Select",""],["","00093171801","WARFARIN ","TAB 6MG","30","Select","Select",""],["","00185012901","BUMETANIDE ","TAB 1MG","30","Select","Select",""],["","65862022701","LAMOTRIGINE ","TAB 25MG","180","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","60","Select","Select",""],["","13668058010","LACTULOSE ","SOL 10GM\/15","280","Select","Select",""],["","69097084507","CYCLOBENZAPR ","TAB 5MG","21","Select","Select",""],["","00378395077","ATORVASTATIN ","TAB 10MG","7","Select","Select",""],["","00093221001","SUCRALFATE ","TAB 1GM","20","Select","Select",""],["","00115521116","COLESTIPOL ","TAB 1GM","60","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","45802086866","POLYETH ","POW 3350 NF","14","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","60","Select","Select",""],["","45802075930","PROMETHAZINE ","SUP 25MG","5","Select","Select",""],["","69230020201","ALLERGY ","TAB 180MG","30","Select","Select",""],["","50428707932","STOOL ","TAB 8.6-50MG","14","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","60","Select","Select",""],["","68180095601","CLOBETASOL ","CRE 0.0005","15","Select","Select",""],["","69315030802","CIPROFLOXACN ","SOL 0.3% OP","2.5","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","68382065105","ISOSORB ","TAB 60MG ER","30","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","SUS 1% OTIC","10","Select","Select",""],["","55566410001","EUFLEXXA ","INJ 10MG\/ML","6","Select","Select",""],["","51991036378","RIZATRIPTAN ","TAB 10MG ODT","10","Select","Select",""],["","51991029301","OXCARBAZEPIN ","TAB 300MG","60","Select","Select",""],["","00603497528","OXYBUTYNIN ","TAB 5MG","60","Select","Select",""],["","64380080438","RANITIDINE ","TAB 300MG","30","Select","Select",""],["","00254200801","COLCHICINE ","TAB 0.6MG","28","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","12","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","55111029336","SUMATRIPTAN ","TAB 100MG","8","Select","Select",""],["","66758019001","KLOR-CON ","TAB 20MEQ ER","30","Select","Select",""],["","61874013030","VRAYLAR ","CAP 3MG","30","Select","Select",""],["","63402030430","LATUDA ","TAB 40MG","30","Select","Select",""],["","31722053712","LEVETIRACETA ","TAB 500MG","60","Select","Select",""],["","68382033405","TRAMADL\/APAP ","TAB 37.5-325","15","Select","Select",""],["","68682000710","DILTIAZEM ","TAB 60MG","180","Select","Select",""],["","00603233832","APAP\/CODEINE ","TAB 300-30MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","12","Select","Select",""],["","67877012450","SILVER ","CRE 0.01","50","Select","Select",""],["","65862041901","SMZ-TMP ","TAB 400-80MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","65162044210","MECLIZINE ","TAB 25MG","15","Select","Select",""],["","16729020301","BUSPIRONE ","TAB 15MG","60","Select","Select",""],["","62756079888","DIVALPROEX ","TAB 500MG DR","120","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}